Knoxville Hospital and Clinics strive to be your healthcare destination, building on compassion and innovation. We are committed to faithfully providing exceptional healthcare. The values we hold true are Teamwork, Innovation, Compassion, Integrity, Service, and People-Centered.
This is a full-time position working Monday-Friday 40 hours a week.
The Oncology Revenue Cycle Specialist is responsible for the end-to-end revenue cycle management of oncology services, including insurance verification, benefits investigation, prior authorization, oncology billing, reimbursement follow-up, and denial management. This position serves as the primary business office resource for oncology patients and oncology-related
services, ensuring timely financial clearance, treatment authorization, accurate claim submission, and reimbursement resolution.
The Oncology Revenue Cycle Specialist works closely with oncology providers, nursing staff, infusion services, pharmacy personnel, scheduling staff, and third-party payers to facilitate
patient access to cancer treatment while optimizing reimbursement and minimizing delays in care.
Essential Functions
- Serve as the primary revenue cycle resource for oncology services, managing insurance verification, prior authorizations, billing, reimbursement follow-up, and denial resolution.
- Verify insurance eligibility, benefits, and coverage requirements for oncology treatments, medications, diagnostic testing, and related services.
- Obtain and track prior authorizations for chemotherapy, immunotherapy, infusion therapies, supportive medications, and other oncology services.
- Coordinate with providers, nursing staff, pharmacy personnel, and payers to resolve authorization and reimbursement issues.
- Review, submit, and follow oncology claims to ensure accurate and timely reimbursement.
- Investigate and resolve claim denials, underpayments, and billing edits, including preparation and submission of appeals when necessary.
- Monitor outstanding accounts and payer responses to support timely claim resolution and payment.
- Maintain accurate documentation related to authorizations, payer communications, billing activity, and reimbursement outcomes.
- Stay current on payer requirements, reimbursement regulations, and industry practices affecting oncology services.
- Participate in initiatives that enhance patient access to cancer care and support the financial performance of oncology services.
- Complete medical records import for oncology patients into EMR for prior authorization and billing functions.
- Other duties as assigned.
Job Requirements:
- High school graduate or GED equivalent
- Preferred two years’ experience in healthcare with knowledge of insurance, authorization, revenue cycle operations
- Mandatory Reporter training certification, or completion with 30 days of hire
- Knowledge of medical/healthcare and insurance terminology
- Exceptional customer service skills required
- Adequate written and oral communication skills and the ability to work independently with minimal supervision are required
- Required to complete all annual competency training and maintain license and/or certifcation
This is a Full-time position and is eligible for benefits for medical, dental, vision, flexible spending accounts, retirement plan with company match of up to 6%, accrued hours for vacation and sick time, paid holidays, and company benefits for employee life, employee AD&D, short term and long-term disability.
